conversations sleep lee
Post on 12-May-2015
176 Views
Preview:
DESCRIPTION
TRANSCRIPT
Good Night,
Sleep Tight:
Understanding the
Importance of Sleep
Conversations at the Royal
Elliott Lee MD, FRCP(C) D. ABPN Sleep Medicine, Addiction Psychiatry
D. Amer Board of Sleep Medicine
Assistant Professor, Royal Ottawa MHC December 19, 2013
• Functions of sleep
• Factors affecting sleep - Quantity - Quality - Timing
• Is sleep an issue for you?
• Obstructive sleep apnea, Narcolepsy
• How to improve sleep
Outline
Arianna Huffington, Internet publishing pioneer President and Editor In Chief, Huffington Post Media Group
Approximately what percentage of our (adult) lives will be spent sleeping? A) 20% B) 25% C) 33% D) 40% E) 50%
Approximately what percentage of our (adult) lives will be spent sleeping? A) 20% B) 25% C) 33% D) 40% E) 50%
Why Study Sleep? We spend 1/3 of our lives sleeping
Severe health consequences - DEATH!
Sleep deprivation costs
$150 BILLION/yr in lost
productivity (Nat’l Commission on Sleep Disorders, 2003)
Functions of Sleep Body /brain repair
- Increased resilience to stress/injury
Pain Reduction
Mood regulation
Diminished anxiety
Memory and learning
Immune competence
Sleep Characteristics by Stage NREM
- Stage N1 + N2 (light sleep) Motor skill learning? - Stage N3 slow wave (deep) Restorative function Memory
REM (rapid eye movement) - Dreaming (85%) - Memory ? - Mood regulation ?
SLEEP HYPNOGRAM
REM
N3
N2
N1
W
1
Hours
1 2 3 4 5 6 7
Sleep factors impacting performance
Sleep Quantity
Sleep Quality
Sleep Timing
(Sleep Inertia)
What is the commonest cause of excessive daytime sleepiness in the community?
Chronic Insufficient Sleep
What is the commonest cause of excessive daytime sleepiness in the community?
Sleep QUANTITY
Sleep Deprivation According to the most recent General Social Survey
done by Statistics Canada (2010), 46% percent of Canadians will cut back on sleep in order to add time to their days.
Sleep Deprivation There is a conflict between the biological imperative
for sleep and the social demand for performance. This poses a fundamental question: What happens to performance when the pressure for sleep is increased?
Sleep Quantity Too little – equivalent to functioning with 0.05 blood
alcohol level (<6 hours)1
<7 hours – decrements can be seen in performance
Cognitive function > speed > accuracy2,3
2Koslowsky M and Babkoff H. Chronobiol Intl. 1992; 9(2); 132-6 3Reilly T and Edwards B. Physiology and Behaviour. 2007; 90; 274-84
1Williamson AM and Feyer AM. Occup Environ Med 2000; 57; 649-55
Sleep Disorders - Socioeconomic Consequences More than 100,000 motor vehicle accidents annually
are sleep-related (US).
“Toronto syndrome”
Psychomotor Vigilance Task (PVT) errors with
cumulative sleep deprivation
Dinges et al Sleep, 1997; 20(4), 267-77
Challenger Disaster
3 Mile Island
Chernobyl
Exxon Valdez
Medical Errors
Transportation Industry
Daylight Savings and Traffic Accidents
Coren S. N Engl J Med. 1996 Apr 4; 334(14): 924
Sleep Deprivation and Wt gain? Women who sleep <5 hours per night, gained 2.5 lbs,
cf. to women sleeping 7 hours/night
Relative risk for obesity (BMI > 30 kg/m2) 5 hour sleepers = 1.15 cf. to 7+ hours
Studied >68 000 women (Nurses Health Study) for 16 years
Hormones? Basal metabolic rate?
Sleep Deprivation and Children Not the same as adults
May be “hyperactive” - fidget - poor attention - cranky
Sleep QUALITY
Sleep Quality Fragmented sleep
consequences are similar to sleep deprivation - ↓ concentration - ↓ attention - moodiness/irritability - ↓ reaction time - memory impairments
Causes of fragmented sleep: - Temperature - Light* - Noise - Pain - Anxiety/Stress - Sleep disorder - Snoring/Apnea - PLMs/RLS
Sleep TIMING
Sleep Control
Process S(leep)
Process C(ircadian)
Process S(leep) Homeostatic control
“The longer we’re awake, the more sleep debt we accumulate i.e. the sleepier we become”
The sleepier we are, the more deficits are seen
To date, there is no surrogate available for good quality sleep.
Process S(leep) Homeostatic control
“The longer we’re awake, the more sleep debt we accumulate i.e. the sleepier we become”
The sleepier we are, the more deficits are seen
To date, there is no surrogate available for good quality sleep.
Process C(ircadian) Sleep tendencies follow a circadian (daily) rhythm
This is controlled by a central “biological clock”
Several inputs also influence this clock, especially - Light - Melatonin
Sleep and Light
SLEEP
11 PM 7 AM
SLEEP SLEEP
Sleep and Light
SLEEP
11 PM 7 AM
SLEEP SLEEP
Sleep and Melatonin
SLEEP
11 PM 7 AM
SLEEP SLEEP
Consequences of Asynchronous Sleep
Impaired continuity of sleep
↓ alertness
↑cognitive errors
Like “hitting a tennis ball off the centre of the racquet” – sleep is not as efficient, and sleep architecture is disrupted
Jet lag, shift work
Who is more likely to do rotating or evening shifts in Canada, men or women?
WOMEN
Who is more likely to do rotating or evening shifts in Canada, men or women?
Women are more likely to work rotating shifts or evening shifts
Other 12%
Evening 14%
Night 8%
Rotating 41%
Irregular 25%
Women
Other 13%
Evening 10%
Night 8%
Rotating 34%
Irregular 35%
Men
Source: Williams C. Worklife Balance of Shift Workers, Stats Canada General Social Survey, 2005
Shift Work International Agency on Research and Cancer (IRAC)
classified shift work as a probable carcinogen in 2007.
40-50% increase in breast cancer risk with >20-30 years of shift work exposure.
Melatonin thought to play a key role; reduces estrogen levels and shown to have anticancer properties.
Grundy A et al. Occup Environ Med. 2013; 70: 831-8
Shernhammer ES and Hankinson SE. Cancer Epidemiol Biomarkers Prev 2009; 18: 74-9
Megdal et al. Eur J Cancer. 2005; 41: 2023-32
Is sleep an issue for you? Do you feel satisfied with the quality of your
sleep?
Do you frequently fall asleep if given a sleep opportunity (a sleep opportunity is defined as a quiet, dark environment for at least 10 minutes)?
Do you usually need an alarm clock to wake you?
Do you tend to catch up on sleep during the weekends?
Once awake, do you feel tired most mornings?
Do you frequently take naps during the day?
Is sleep an issue for you? When you can get it, do you consistently sleep
more than 9.5 hours per night?
Do you feel lethargic or slow throughout the day?
Do you sleep longer during times of depression, anxiety and stress?
Do you snore?
Do your legs bother you at bedtime, interfering with your sleep?
What Happens at the Sleep Lab… ROMHC: 5 bed clinical lab, 4 bed research lab STEPS: 1) → Referral 2) → Consultation with a Sleep Specialist 3) → Overnight Sleep Study 4) → Data is Analyzed by RPSGTs 5) → Results Appt with a Sleep Specialist
How Do We Measure Sleep in the Laboratory?
Electrophysiology
EEG – brainwaves (Central & Occipital Leads)
EOG – eye movements
EMG – muscle tone
EKG – heart
Breathing:
1)Airflow
& 2) Effort: Thoracic & Abdominal
Blood oxygen saturation (SaO2)
Audio-visual recording
Obstructive Sleep Apnea (OSA) Definition:
The presence of abnormal breathing disruptions/cessations (apneas) during sleep
Sleep is disrupted temporarily, usually without recall. As a result, sleep deprivation and/or excessive daytime sleepiness occur, usually with snoring at night
Up to 25% of men and 9% of women are thought to be affected, with 90% of patients likely undiagnosed1
50% of snorers are thought to have OSA2
Strongly associated with cardiac disease
1Young et al. N Eng J Med, 1993; 328(17): 1230-5 2Lugaresi et al. Sleep, 1980; 3(3-4): 221-4
Months
Marin JM et al. Lancet, 2005
Fatal CV events and OSA
Nonfatal CV events and OSA Marin JM et al. Lancet, 2005
OSA Consequences
Memory problems Irritability, mental illness e.g. depression
Motor vehicle accidents Hypertension
Heart attack and stroke Impaired
glucose
control
Treatments for OSA **Weight loss - ↓ BMI = ↓ RDI Avoid alcohol consumption and sedative medications “Snoreball” technique / positional therapy Upper airway surgery
Tonsillectomy (pediatrics) Uvulopalatopharyngoplasty (UPPP) Maxillomandibular Advancement (MMA) Tracheostomy
Provent Oral Appliances - Mandibular Repositioning Devices
(MRDs), Tongue Retention Devices (TRDs) **CPAP – Continuous Positive Airway Pressure
OSA and Attractiveness? Treatment of OSA with
CPAP has been shown to improve attractiveness
Perceived to be - More alert - More youthful - Less forehead creases
Chervin R et al. J Clin Sleep Med, 2013; 9(9): 845-52
All of the following famous people suffer from a
sleep disorder. Which of these famous people
suffers from obstructive sleep apnea? (Choose
all that apply):
A B C D E
All of the following famous people suffer from a
sleep disorder. Which of these famous people
suffers from obstructive sleep apnea? (Choose
all that apply):
A E B C D
Narcolepsy A pathologic disorder of sleepiness during the day –
key symptom – sleepiness
May have insomnia at nighttime
Affects about 1/2000 people
Very underdiagnosed; difficult to recognize
80% may have cataplexy, a REM sleep intrusion phenomenon on wakefulness
Related to cerebrospinal fluid deficiency of hypocretin (orexin)
Narcolepsy Treatment
SLEEPINESS:
– Stimulants d-amphetamine (Dexedrine), methylphenidate (Ritalin) Novel - modafinil (Alertec / Provigil). - armodafinil
CATAPLEXY:
– Antidepressants – e.g. venlafaxine
– Sodium oxybate (Xyrem)
All of the following famous people suffer from a
sleep disorder. Which of these famous people
suffers from narcolepsy?
A B C D E
All of the following famous people suffer from a
sleep disorder. Which of these famous people
suffers from narcolepsy?
E A B C D
How to Improve Sleep Get adequate quantity of sleep (7.5-8.5 hrs)
Regular sleep/wake times – timing/routine important
Develop a relaxing pre sleep ritual - relaxation exercises can be helpful - avoid stressful/stimulating activities prior to sleep
Avoiding prolonged naps* in the day
Bed – only for sleep (and romance!)
Avoid clock watching
Rule out sleep disorder, psychiatric disorder
How to Improve Sleep Sleep Environment
- Avoid environmental disturbances - Partner/Children - Roommate - External noises – phones, texting, external (white noise generator may drown out) - Avoid bright light in evenings - Temperature – slightly cooler (<21-22oC) is better. drop in temperature facilitates sleep onset - Bed should be comfortable – consider memory foam mattresses/pillows; queen or king size beds
Quiet. Dark. Cool. Comfortable.
Detriments to Sleep Light (evening)
- cell phones, computer
Stress (cortisol - steroid)
Caffeine
Nicotine
Alcohol
Marijuana
Drugs (Amphetamines, cocaine, opioids*)
Which of the following substances has the highest amount of caffeine? A) Red Bull, 250 mL B) Coca Cola, 1 L C) Starbucks Coffee, Grande (360 mL) D) Green Tea, 300 mL E) Caffeine pill, (200 mg tab)
Which of the following substances has the highest amount of caffeine? A) Red Bull, 250 mL B) Coca Cola, 1 L C) Starbucks Coffee, Grande (360 mL) D) Green Tea, 300 mL E) Caffeine pill, (200 mg tab)
Caffeine – a Canadian Love Affair
Starbucks coffee(20 oz) 400 mg
Second Cup coffee (20 oz) 400 mg
Tim Horton’s coffee (20 oz) 270 mg
Instant coffee (8 oz)* 95 mg
Tea (leaf or bag, 8 oz) 50 mg
Mountain Dew (12 oz) 55 mg
Coca Cola (12 oz) 45 mg
Red Bull (250 ml) 80 mg Sources: National Coffee Association, National Soft Drink Association, Tea Council of the USA, and information
provided by food, beverage, and pharmaceutical companies and J.J. Barone, H.R. Roberts (1996) "Caffeine
Consumption." Food Chemistry and Toxicology, vol. 34, pp. 119-129.
Summary Sleep is important to consider for performance
Good sleep can improve performance - Cognition/memory - Accuracy - Speed - Health/Decrease sick days (immune competence) - Improve mood, anxiety, resilience
Sleep variables to consider: Quantity, Quality, Timing
Rule out sleep disorder
Details are important; BALANCE – key to success
When the time to perform has come, the time to prepare has past. Bob Bowman, coach of Michael Phelps
Thank You! Questions?
Severe OSA, treated with CPAP
12 AM 10 PM 2 AM 4 AM 6 AM
Video courtesy of Joe Santos, IOSleep Med
Video courtesy of Dr. Viozzi, Mayo Clinic
Maxillomandibular Advancement
5 mm
5 mm
+8 mm
Mandibular Repositioning Devices (MRDs)
Silencer-
Johns Dental
Labs
Klearway-
Great Lakes Orthodontics
top related